MEDICAL POLICE.
With the exception of the Quarantine laws, which on account of their superior importance have been treated in a separate chapter, and some incidental, rather than direct, aids which the subject receives from the law of nuisances, &c. there is but little of that regulation in England which can be strictly denominated Medical Police.[[217]] We have already expressed our opinion upon the apparent inattention of our Government to this branch of legislation, and have considered it as the necessary consequence of the cleanliness and good order by which this nation is so pre-eminently distinguished; there are, however, some very material points, the value of which is acknowledged by local adoption, while no good reason has been adduced against their general extension; these are the examination of drugs and medicines by the Censors of the College of Physicians; the Irish Health Act; and the weekly Bills of Mortality.
It has been remarked from the Bench, that there might be particular reasons for taking especial care of the health of the Capital; granting this to be true, it still appears extraordinary that no measures of precaution should have been adopted to prevent or restrain the sale of factitious, impure, spoilt, or deleterious drugs or medicines, in any part of England, excepting only the city of London; while it is evident that from various causes, such as greater and more rapid sale, general competition, superiority of purchasers, and facility of detection, frauds or negligences are less likely to happen in the metropolis than in the provinces; where the slowness and uncertainty of demand may in some degree excuse the purchase of originally inferior articles from the wholesale dealers, and will generally account for the subsequent deterioration of the best drugs. It would occupy too much of our reader’s time and attention, and very possibly be considered as irrelevant to the object of the present work, if we were to enter into any details upon this occasion, and to enumerate the different medicinal substances which, although originally genuine, become in a short space of time worse than useless, or whose properties by the operation of local causes are changed or destroyed.[[218]] This is a loss upon which the country practitioner must calculate; but that the inconvenience and danger may not fall upon his patients, it is surely expedient that some authority should be established to examine and destroy, as in London, all spoilt or deteriorated medicines; for this purpose, provincial censors might be nominated by the College of Physicians, either from among their own members, or from the most eminent Licenciates, whose duty it would be to make frequent visits for the purpose of examination, in market towns; and in all other places, whenever they were called upon by any sufficient occasion, or requisition.
Another equally important restriction is requisite as well in London as in the provinces, against the sale of poisonous, or highly dangerous drugs, to unknown persons. A week scarcely elapses without the relation in the public journals, of some awful case of murder, suicide, or fatal accident; surely this is sufficient to shew the necessity of some new enactment on the subject. We are willing to admit that it would be difficult to frame an act which should comprehend and class all the several articles that negligence, folly, or malice might pervert to the destruction of human life: the desired effect would, however be best attained by giving to some competent authority the power of publishing and enforcing, from time to time, such regulations and restrictions as might be found practically necessary. Arsenic, for example, is of all others, the poison most easy to procure, under various pretences; while from its exceeding virulence, insipidity, and other qualities, it is most fatally adapted to the horrible purposes of murder. The general pretext for its purchase is that of the intended destruction of vermin; now if mixed with one hundred times its weight of tallow it would be equally, if not better adapted to the avowed object, while at the same time it would be thus rendered an inapplicable instrument for the perpetration of crime. On other occasions it might be combined with some highly nauseous and colouring material; but it ought never to be sold in a pure form, except to persons who are well known, and whose ordinary trades and occupations justify their application for a supply. Laudanum, or Opium, from its nauseous taste and smell, is seldom applied to the purpose of murder, except by suicides; against the sale of these drugs it would be most difficult to guard, although many fatal results might have been averted by vigilance and judicious precaution; the Chemist or Apothecary cannot with propriety refuse it, but he is not bound to supply more than a single dose to a stranger, and that should be mixed with some appropriate vehicle, in order to prevent the designing applicant collecting from shop to shop a quantity sufficient for any criminal purpose. And we are of opinion that the master, or principal assistant, should be alone allowed to dispense dangerous medicines. The careless substitution of one drug for another must be also considered as a prolific source of mischief; this frequently happens in the shop of the chemist or druggist, where it is least excusable; at other times it occurs from the negligence of some individual, who leaves a poisonous substance in company with articles that are intended for ordinary use. Oxalic acid, to which so many deaths have been lately attributed, may serve as an instance; in its external characters it bears such a resemblance to those of common Epsom salts, as readily to deceive the ordinary observer; and as both substances very frequently become articles of retail custom, they are usually kept ready for sale, in parcels of an ounce each, a practice which renders a careless substitution an error of common occurrence; the employment of a particularly coloured paper, that of yellow for instance, if used universally as a wrapper for poisonous articles, upon which also the word poison, or dangerous, might be legibly printed, would to a certain degree guarantee the safety of the purchaser; but as danger might notwithstanding be apprehended in the night, a paper of a distinct texture might afford additional security; the peculiar roughness of the Dutch filtering paper which is manufactured from woollen would answer such a purpose. The labels of phials should in this particular correspond with the wrappers of dry substances; if the distinction were once generally adopted by the various dealers, it would soon become notorious to indifferent individuals, and many fatal accidents might be prevented, without the aid of legislative enactment.[[219]]
The College of Physicians, or a mixed Committee of the Medical Bodies, might be best entrusted with the powers of regulation to which we have alluded; while to obviate the jealousy to which such an extension of their authority would be likely to give rise, a clause might be introduced, that no regulation should be binding, until sanctioned by a certain number of the judges, as is done in some other cases of inferior jurisdictions.
It would be also expedient to establish some summary jurisdiction by which fumigation, whitewashing, and other cleansing operations, and the burning of infected clothes, might be effected without delay, whenever the prevalence of a contagious disease required it. The Irish Health Act (59 Geo. 3. c. 41, see Appendix, p. 164) might also be extended to such places in England as by authority should be, from time to time, declared infected.
BILLS OF MORTALITY.
Bills of Mortality were instituted in the city of London in the year 1592, in order to collect and exhibit the number of deaths, and to record the progress, diffusion, and decline of the epidemic malady, with which the city was at that time infested; but upon the cessation of the plague, the bills were discontinued. It appears, however, in consequence of the recurrence of the sickness, that they were reestablished by public order in 1603, and on the 29th of October in the same year, being the first of the reign of King James, the establishment of a regular series of weekly bills of death commenced. In 1606 the number of christenings, as well as that of burials, appeared in the returns, and although diseases and casualties were recorded as early as 1604, no public notice was made of either before the year 1629, when another important improvement took place—that of distinguishing between the sexes. In 1728 the ages[[220]] of all who died from under two years of age and upwards were regularly specified, and this may be considered as the last[[221]] improvement which the bills of mortality have received; for notwithstanding the rapid march of those arts and sciences with which every branch of statistics is so intimately connected, the contents, arrangement, and language of these bills have remained unchanged. The collating, printing, and publishing these documents, as far as they relate to the metropolis, are placed under the superintendance and jurisdiction of the ancient corporation of parish clerks:[[222]] a power which it is hardly necessary to observe is wholly inadequate to the accomplishment of the medical, political, and moral objects which these bills are calculated to promote. As to the nature of the diseases of which persons die, much error must necessarily arise from the absurd manner in which the investigation is conducted, as the following statement will clearly demonstrate.—The churchwardens of each parish within the bills of mortality, appoint two old women to the office of Searchers, who, on hearing the knell for the dead, repair to the sexton of the parish, to learn the name and residence of the deceased. They demand admittance into the house to examine the body, in order that they may see that there is nothing suspicious about it, and judge of what disease the person died, which they report to the parish clerk. The regular charge for the performance of this office is fourpence to each searcher; but if an extra gratuity be tendered, they seldom trouble the domestics with any examination. We entirely agree with Dr. Burrows[[223]] in thinking that the office, as at present filled, should be entirely suppressed; and the attestation of a properly qualified medical practitioner, upon actual knowledge of the disease of which the person died, or upon inquiry and examination of the body, should be substituted. Were competent persons only appointed to report, the nomenclature[[224]] and classification of diseases, in which there has been little variation since the origin of the bills, would consequently be reformed; and we should then derive from them the elucidation of many important and dubious medical points, as 1. The causes of many diseases, and their affinity to one another. 2. The rise, situation, increase, decrease, and cessation of epidemic and contagious diseases. 3. The means of guarding against their extension and effects. 4. The comparative healthiness of different countries and places, climates, and seasons. 5. The influence of particular trades and manufactures on the human constitution. Such are the medical advantages which would arise from correct and enlarged bills of mortality. Dr. William Heberden[[225]] has made the following observations upon this subject: “People have fallen into two opposite errors concerning the Bills of Mortality; some have considered their authority as too vague to be made the foundation of any certain conclusions; and others have built upon this foundation, without sufficiently considering its real defects. Both parties are equally wrong. The agreement of the bills with each other does alone carry with it a strong proof that the numbers under the several articles are by no means set down at random, but must be taken from the uniform operation of some permanent cause. While the gradual changes they exhibit in particular diseases, correspond to the alterations which in time are known to take place in the channels through which the great stream of mortality is constantly flowing. That there are, however, many and very great imperfections in these bills cannot be doubted; for, First, the births include only those who are baptized according to the rites of the church of England, by which means all Jews, Quakers, and the very numerous body of dissenters are omitted. Secondly, of those who are of the church of England, a very large proportion are either buried in the country, or in burial grounds adjacent to London, but without the bills; the burials also in St. Paul’s Cathedral, in Westminster Abbey, the Temple, the Rolls, Lincoln’s Inn, St. Peters in the Tower, the Charter-house, the several hospitals of the metropolis, and other places which are not parochial cemeteries, are for that reason omitted; besides which, the great parishes of Mary-le-bone, and Pancras, have never yet had a place in the bills of mortality. Thirdly, many abortives and still-born are noticed in the deaths, but not in the births.” Dr. Heberden proceeds to examine the fluctuation observable in certain diseases, and which he considers under two distinct points of view; the first comprehending their variations in different years; the second those which take place in different parts of the same year; we must refer the reader for much curious matter, and useful information, to his work above cited. Many of the provincial bills of mortality are more perfect than those of London, a superiority for which we are indebted to the eminent physicians who have resided in those districts, in example of which we have only to refer to those of Chester by Dr. Haygarth,[[226]] of York by Dr. White,[[227]] while from the returns of Northampton Dr. Price computed his celebrated tables of the probabilities of life, and in a curious memoir read before the Royal Society he advances strong reasons for believing that there is a prodigious preponderancy in favour of the country above the most healthy cities.[[228]] We shall conclude this subject with observing, that the metropolitan bills establish beyond all doubt the gratifying fact of the superior healthiness of London, notwithstanding its increase of population, in the present day to what it was during the seventeenth century, when the deaths exceeded the births, by more than one half of the whole number; while in the present age, the sum total of births exceeds that of deaths; the same improvements have taken place also in the provinces, and we are borne out by the concurrent testimony of our best political arithmeticians, in the assertion that the value of human life is increasing in Great Britain, while the diminution in the number of certain diseases, and the total extinction of others, offer the surest proofs of the general amelioration that has taken place in our national habits and manners.
Medical Jurisprudence.